Incidence of spinal trauma has increased in modern warfare

20th September 2013

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Andrew Schoenfeld (Robert Wood Johnson Clinical Scholar, the University of Michigan, Michigan, USA) and others report in Spine that the incidence of spine trauma during the wars in Iraq and Afghanistan is higher than that reported in previous conflicts. A possible reason for this increase may be because some injuries that were previously fatal, due to medical advancements, are now survivable.

Schoenfeld et al state that although previous studies have indicated that the incidence of spinal trauma (among American military personnel) has increased in modern warfare, limitations (such as not defining the population at risk) of these studies has made generalising their findings to the American military as a whole difficult. They write: “This investigation was designed to provide information regarding the incidence and extent of combat-related spine wounds in the conflicts in Iraq and Afghanistan using a population at risk derived from the records of the Defense Manpower Data Center.” The authors identified wounded personnel with spinal injuries through a manual search of the Department of Defense Trauma Registry (DoDRT).

Of 7,877 combat casualties that occurred between 2005 and 2009, 872 (11.1%) included one or more instances of spinal trauma. Schoenfeld et al write: “In total, 1,292 distinct spinal injuries were identified, with a mean of 1.5 spine wounds per injured solider.” The most common mechanism of injury was explosions (74.5% of injuries), the most frequently involved region was the lumbar spine (40%), and spine fracture was the most common injury (91% of all casualties). The overall incidence rate for spine trauma in the study was 4.4 per 10,000 and the rate of spine fracture was 4.4 per 10,000. The authors report: “The 11.1% rate of spinal injuries encountered in this investigation represents the highest published statistic for Iraq, Afghanistan, or any other American conflict.”

According to Schoenfeld et al, the substantial increase in spinal injuries in modern wars compared with previous conflicts may be a result of enhanced personal protection and medical advancements, “that have increased survivability among the combat injured, allowing soldiers to survive wounding mechanisms that would previously have proven lethal.” Another possible reason for the increase is “enemy combatants’ reliance on explosive mechanism of assualt.”

Concluding, the authors write: “Our results confirm notions expressed in prior works that the incidence of sine trauma in modern warfare exceeds that encountered in earlier conflicts, perhaps by a factor as high as 10.”

Schoenfeld told Spinal News International: “The main take home message of this article is that there is a marked increase in combat casualties with spinal trauma from the wars of the last decade as compared to prior conflicts. This is important to recognise on the part of military medical planners as well as agencies, such as the Veterans Administration, that will take care of service members following war injuries. To increase the safety and survivability of our soldiers at war enhanced training in the detection and emergency management of spinal injuries may be necessary.”